Peripheral Arterial Disease

#1 - Introduction and Pathophysiology of PAD

I. Magnitude of the Problem
II. Natural History of Peripheral Arterial Disease
III. PAD-Progression of Symptoms
IV. Diagnostic Strategies
V. PAD Portal
VI. Therapeutic Lifestyle Changes
VII. Physical Activity
VIII. Exercise Prescription-ExRx
IX. Exercise Capacity and Mortality
X. Smoking Cessation
XI. PAD-Summary

Behavioral/Learning Objectives:

1. Define Peripheral Artery Disease and the prevalence of it in the US.
2. List the symptoms associated with PAD.
3. Be able to discuss what role the community-based screenings provide in the prevention of PAD.

#2 - Screening Modalitites and Carotid Artery Disease

I. Vascular Specialists
II. Diagnostic Strategies

• Physical Exam
• ABI
• Ultrasound
• Angiography
• CT
• MRA

III. Carotid Artery Disease Stroke
IV. Stroke Risk Factors
V. Stroke Symptoms
VI. Time to Presentation
VII. “Clot Busting” Drugs
VIII. CT Scan
IX. Duplex Imaging
X. Ischemic Stroke
XI. Treatment of Carotid Stenosis
XII. Carotid Endarterectomy
XIII. Carotid Artery Stenting
XIV. Stroke Prevention

Behavioral/Learning Objectives:

1. Define the role of a history and physical exam in the diagnosis of PAD.
2. Describe ABI norms/index interpretation.
3. List 3 signs/symptoms of a stroke.

#3 - Atherosclerotic Progression and Treatment Options

I. Atherosclerosis Timeline
II. Contemporary Management
III. Major Risk Factors
IV. Medical Therapy
V. Causes of High Cholesterol and Triglycerides
VI. Obesity and Risk of Death
VII. Plaque Stabilization
VIII. Metabolic Syndrome
IX. High Risk People
X. Detection of Asymptomatic Disease
XI. Underestimated Risk in Women
XII. Emerging Risk Factor
XIII. Balloon Angioplasty
XIV. Bypass Surgery
XV. Prevention and Treatment of Ischemic Events
XVI. SUMMARY

Behavioral/Learning Objectives:

1. Describe the role of medical management in PAD.
2. Describe the role of lipid lowering therapy in the treatment of PAD.
3. Describe the role of catheter based and surgical interventions in PAD.
4. List at least five measures to prevent PAD.

#4 - Therapeutic Lifestyle Changes

I. Assessment

A. Low Risk Patient Profile

1. Blood pressure < 120/80 mmHg
2. Total cholesterol <160 mg/dl
3. HDL > 45 mg/dl men
4. HDL > 65 mg/dl women
5. LDL < 100
6. Non-smoker
7. Normal BMI

II. Current risk factors

A. Dietary habits

B. Exercise habits

C. Psychosocial status

D. Blood pressure

E. Lipids

F. Blood glucose

G. Smoking cessation

H. Stress management

I. Weight management

A. Other Risk Factors

1. Small HDL cholesterol
2. Lipoprotein(a)
3. Metabolic syndrome X
4. Hs CRP (high sensitivity C reactive protein)
5. Homocysteine
6. Small, dense LDL cholesterol

A. Diet high in cholesterol and saturated fat

B. Disorders

1. Diabetes mellitus
2. Obesity
3. Alcohol consumption
4. Renal failure
5. Systemic lupus erythematosus
6. Lipodystrophy
7. Glycogen storage disease

C. Causes associated with insulin resistance

1. Hypertriglyceridemia
2. Overweight/obesity
3. Physical inactivity
4. Type II diabetes

D. Other causes

1. Cigarette smoking
2. Very high carbohydrate intake (> 60% of calories) anabolic steroids, progestational agents)

A. Obesity (Viseral abdominal)

1. Men waist > 40 inches
2. Women waist > 35 inches

B. Triglycerides >150 mg/dl

C. HDL “good cholesterol”

1. Men < 40 mg/dl
2. Women < 50 mg/dl

D. Blood Pressure > 130/85 mmHg

E. Fasting Blood Glucose > 110 mg/dl

A. These are High Risk People who have an >20% of having CHD in 10 years.

1. Describe the role of medical management in PAD.
2. Describe the components of Metabolic Syndrome.
3. Describe 3 ways that hyperlipidemia can be addressed.

#5 - Exercise Testing and Training

I. Questionnaires
II. The San Diego Claudication Questionnaire
III. Walking Impairment Questionnaire (WIQ)
IV. Medical Outcomes Study Short Form (SF36)
V. The PAD Quality of Life Questionnaire (PADQL)
VI. Physician supervised testing due to high risk of CAD
VII. Various types of exercise tests available
VIII. TM test
IX. Arm ergometry test
X. Pharmacologic stress test
XI. Recommendations to Improve Functional Status (Capacity)
XII. Exercise Prescription ExRx
XIII. Exercise-rest-exercise pattern
XIV. Supervised vs. non-supervised
XV. Intensity

A. Initial workload

A. Brief rest period or slowing down (2 or 2+)

A. mild pain

B. mild to moderate pain

C. moderate pain

D. severe pain

A. Ultimately 35-50 minutes of continuous walking

XIX. Frequency – weight bearing activity 3-5 days per week

XX. Specificity – use of weight bearing activity is critical for improvement

XXI. Other components to treating PAD

XXII. Smoking cessation class

XXIII. Dietary counseling

XXIV. Psychological counseling

Behavioral/Learning Objectives:

1. Be able to discuss the various graded exercise testing options for PAD patients.
2. Discuss the components of an exercise prescription for PAD.
3. Review the types of questionnaires that can be used for PAD assessment.

#6 - PAD Rehabilitation

I. Patients eligible for PAD rehabilitation

A. Absence of other co-morbidities (Cardiac or Pulmonary)

A. Initial evaluation

B. Convenient to attend

C. Clinically effective at decreasing IC symptoms

A. Supervised, hospital or outpatient clinic based

B. Supervised 3-6 month program

A. Set reasonable expectations

B. Stress the continued life-long role of exercise

C. Teach the use of exercise diaries

D. Stress other benefits of exercise that impact on risk factor modification

E. Discuss fears such as reproduction of IC pain, angina, amputation and death

F. Physician and employer support for program participation

G. Offer written home exercise instructions

A. Lack of recognition of prevalence of PAD and IC

B. Limited awareness of scientific evidence supporting exercise for PAD

C. Lack of Reimbursement for PAD rehabilitation

Behavioral/Learning Objectives:

1. Describe 2 reasons why PAD prevalence is underestimated.
2. List 3 components of a successful PAD program.
3. Explain potential barriers to establishing a PAD exercise program and how to over come them.

Accreditation Information

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR.) Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Cardiovascular Techs – Cardiovascular Credentialing International recognizes our approved provider status with the ANCC for continuing education courses for CCTs.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Respiratory Therapists - This course meets the requirements for continuing education for Respiratory Care Professionals in AL, CA, CT, DE, FL, ID, IL, IN, IA, KS, LA, ME, MA, MN, MS, MT, NE, NV, NY, OH, OK, OR, RI, SC, TN, TX, WA, WV, WY.

Because each state’s continuing education requirements for respiratory therapists is subject to change, please verify this information with your state board. Thank you.

Physical Therapists - PTs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, CO, CT, HI, IA, ID, IN, KS (Cat 2), MA, ME, MI, MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10.

The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, OK (Cat 2), TN (Cat 1), WI.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.

Learn more about Academy Medical's presenters

View details about past webinars

Already Registered: login, take post-tests or listen to a recorded webinar